The following is a series of email articles I wrote for a "Biggest Loser" group at school dedicated to helping everyone find a balanced approach to achieving an ideal body weight.
Forget the fiction, here are the facts...
First things first on your quest for your ideal weight....
If you could do one thing to kick off your quest for your ideal weight, just one thing, that when implemented will kick start your weight loss and improve your health right from the start, what would that be? Of course exercise, that is a given, look who’s writing this. J What else?
No, not diet. Please do not start a diet. What’s the first three letters in the word diet? Please do not fall for any fad diets, any cleanses, diet pills or drinks…that stuff doesn’t help in the long run, I promise you. There is no quick fix or magic potion out there. As Mr. Gold (AKA Rumplestiltskin) says, “Magic always has a price” and he is right. The price is usually a rebound effect at a minimum and poor health or worse at the extreme.
Any good trainer will tell you that the majority of your training occurs in the kitchen. The key is not to cut out food by going on a diet, but to embrace food and eat yourself to your ideal weight. That’s right, eat for the weight you want to be, not for the weight you want to lose (more on that in a future article). So what is step number one? Add fiber and drink water. That’s right, something so simple can be very, very powerful. Women, on average, should have about 28 grams of fiber a day and men should have about 35 grams split fairly evenly in meals and snacks. Now, I am not talking about a fiber pill, supplement or any quick delivery super fiber made in a lab, I am talking about eating real food.
Why focus on eating enough fiber? The average person carries around 5-25 pounds of fecal matter in his or her intestines at any one time depending on their diet. Making sure that every meal has 5-10 grams of fiber from vegetables, fruit, and/or grains will help you carry less weight in fecal matter around with you over time, while avoiding the loss of lean mass, decrease in metabolism, energy loss, and rebound effect that occurs with most “cleanses” or very low calorie diets. Studies have shown that fiber helps lower the risk of cardiovascular disease, obesity, metabolic syndrome, constipation, etc. Click on the following link to read an article from Kathleen Zelman, MPH, RD, LD of WebMD to learn a little more about the health benefits of fiber and what are the best sources: Fiber, how much do we need?
Happy Training! Sincerely, Mitchell S. Simon, D.C. Next step to to achieving your ideal weight...
Once you have incorporated exercise, water and fiber (from veggies, grains, and fruits) into your daily habits, what is the next thing to do to ensure you are on the fast track to achieving your ideal body weight? Answer, eat high quality protein at every meal. The average sedentary individual needs about 0.8 grams of protein for every kilogram of body weight. Individuals that exercise heavily may need over twice that amount. A 200 pound sedentary man needs about 72 grams of protein a day [(200lb/2.2 lb per kg) x 0.8 gram protein= 72 grams protein]. If he is training heavily, he should consume approximately 140+ grams of protein daily.
Personally, I prefer to get my protein from animals (eggs, meat, poultry, fish and pork), beans, rice, nuts, etc. instead of the processed powdered forms; however, I am not opposed to most other people using the various forms of protein supplementation. Some coaches and trainers may argue that it is necessary to use different types of proteins pre and post workout to aid in recuperation, muscle growth, performance, etc. and studies tend to support their assertions. I, on the other hand, enjoy eating real food far too much to want to replace a meal with some highly processed, foul tasting, “naturally flavored” @#$%&!
Most people have no problem getting enough protein on a daily basis until they start cutting calories in an effort to lose weight. Then there are those on the other end of the spectrum that eat up to 4 grams of protein or more per kilogram of body weight. Should they be concerned? Click on the following link to read about high protein diets and its role in weight loss. http://www.webmd.com/diet/guide/high-protein-diet-weight-loss
Happy Training!
Sincerely, Dr. Simon
High carb, low carb, no carb...what am I suppose to do?
There are a lot of myths and misconceptions floating around about nutrition, and this is especially true when it comes to carbohydrates. Once again, when in doubt, pull the textbooks out. It is important to remember that our brain feeds exclusively on glucose, the most basic molecule carbohydrates are broken down into through the process of digestion. It is estimated that we need about 130 grams of carbohydrates a day just to feed our brain. Since carbohydrates are 4 calories a gram, we need to consume at least 520 calories a day from carbohydrates (130g x 4 calories per gram) just to maintain normal brain activity. Not really interested in thinking clearly and only interested in burning fat? Think about this, at least 50-100 grams of carbs a day are required to prevent ketosis (high levels of ketones in the bloodstream) which results from the incomplete metabolism of fatty acids. That’s right, fat burns in the flame of carbohydrates, so you have to eat carbs if you want to burn fat efficiently!
How many carbs you consume beyond what I described above is based on your activity levels. Glycogen is the storage form of glucose in the body. Approximately 300 grams (1200 calories) of glycogen can be stored in muscle and 75-100 grams stored in the liver. Because dietary carbohydrates replace muscle and liver glycogen used up during exercise, especially very intense exercise, there is no one size fits all amount of carbohydrates a person should consume. According to the NSCA’s Essentials of Personal Training, endurance athletes that train aerobically for long durations of 90 minutes or more should have between 7-10 grams of carbohydrates per kilogram of bodyweight. Just about everyone else can get away with just half of that (5-6 gram per kg body weight). Therefore, a 200 lb (90.9 kg) active male that does not exercise aerobically for an hour or more a day may have as much as 450-545 grams of carbohydrates per day. That is approximately 1800-2180 calories a day from carbohydrates alone.
So in review:
No carbs, no way, that is just plain silly and potentially dangerous.
Low carbs, sure if you are sedentary or have very low activity levels.
High carbs, only if you are an endurance athlete training aerobically for 90 minutes or more a day.
The answer for the majority of us is to have a moderate carbohydrate intake based on goals, training regimen, fitness level, personal taste and eating preferences.
Feeling good about fat once again...
I am sorry to have to be the one to tell you; but, you have been the lied to, scammed, and hypnotized into believing that fat is bad for you. High carb, low fat diets have been touted as the healthier way to go for the last few decades; not necessarily because they are good for you; but, because there is billions and billions of dollars to be made from you eating low-fat, no fat, or fake fat foods. The low-fat revolution paved the way for high fructose corn syrup to invade our food system and not only fatten up the American population; but, help to make it disease ridden as well.
Well, I am here to break the spell and help you fall back in love with all sources of the glorious fat molecule. Up to one-third of all calories we consume should come from fat. That’s right, one third! We should consume between 20-35% of our calories from fat every day in order to have healthy cells, normal hormone balances, and to feel satisfied after a meal. We need fat in our diet to feel happy. What about good fats and bad fats, you might ask? Aren’t animal and trans fats bad, and only plant fats good for you? Not really, you need an equal balance of all types of fats: saturated, unsaturated, and polyunsaturated. So if 30% of your calories need to come from fat, one-third of those calories should be saturated fat, one-third unsaturated, and the remaining third polyunsaturated. That means each type of fat should represent about one tenth of your total caloric intake. Ten percent of your total calories should come from saturated fat, ten percent from unsaturated fat, and ten percent from polyunsaturated fat.
All fats contain all three types of fatty acids. Milk and meat groups are generally high in fat calories, particularly saturated fat. Trimming your meat will generally lower the total calories derived from fat. Lean cuts of poultry and fish generally have less fat content. Trans fatty acids are found naturally occurring in meat, butter, and milk, and are unavoidable when consuming these foods. Many margarines, commercially sold snack cakes, processed foods etc. contain substantial amounts of trans fats and should be avoided.
Most vegetables, beans, fruits, whole grains, nuts, seeds, and avocados have a high proportion of unsaturated fats, except coconut and palm which are high in saturated fats.
A gram of fat has nine calories, over twice as many as protein and carbohydrates, so be careful, the calories add up fast. Click on the following link to read more about incorporating fat into a weight loss program: http://thechart.blogs.cnn.com/2011/06/10/what-foods-have-healthy-fat/
Happy Training!
Sincerely, Dr. Simon The effect is profound if you write it down...
Fact: If you write it down, you are likely to reach your target weight more quickly than if you do not write it down.
That’s right, the preponderance of both scientific and anecdotal evidence suggests that just by writing down what you eat and the exercise you do throughout the day increases the speed and the amount of weight loss compared to not keeping this running record. One research study cited by Rosanna Gibbons, MS, RD, LDN in the first article below, concludes that using a smart phone app is even more effective for sticking to a weight loss plan than writing it down by hand. So now, in the palm of your hand, you have the most effective form of keeping a food diary and as a bonus, each app is the equivalent of a team of professionals at your 24 hour beck-and-call assisting you on your journey to achieve and maintain your individual ideal body weight. Some of the better ones are even free!
I want you to notice that I still have not given you a specific diet plan or exercise routine to follow. First, I suggested you focus on drinking water and getting from 25-35 grams of fiber a day from vegetables, whole grains and fruits. Then I suggested you make sure you get 0.8 grams of high quality protein per kilogram of body weight from a variety of sources if you are sedentary, and twice that or more if you are a highly trained athlete. In terms of carbohydrates, I suggested you get 7-10 grams from vegetables, whole grains, and fruits per kilogram of body weight if you exercise aerobically for durations of 90 minutes or more a day. If you do not exercise that long, than you can get away with half that much. The rest of your calories should come from a variety of sources of fat, evenly distributed between saturated, monounsaturated, and polyunsaturated for a total of 20-35 percent of the daily calories.
Otherwise, I do not believe there is a one size fits all plan that works for everyone. In other words, a plan that is designed for everyone works for no one well. We all need to find our own unique combination of foods that nourishes us both emotionally, as well as physically, without being in excess to the point that we store the extra energy on our body as fat and carry it around with us all of the time.
We will talk more about calories later. For now, just write it down.
Sincerely, Dr. Simon How many calories do you burn each day?
Before we discuss how many calories (i.e. kilocalorie or kcal) you should eat each day in order to reach your target weight in a healthy manner as quickly as possible, we first need to get an idea of how many calories you actually burn each day. There are a lot of ways to go about figuring it out; however, one of the ways I consider to be most useful is to first estimate how many calories you burn at rest. Then add on any energy burned through activity and exercise, and even consider the energy cost of eating.
Energy expenditure at rest can be likened to the fuel needed to keep a car engine idling. The average human being consumes approximately 3.5 milliliters of oxygen per kilogram of bodyweight per minute while idling (resting quietly) or the equivalent of about 1 kilocalorie of energy per kilogram of bodyweight per hour. For example, I am a 195 pound (88.6 kilogram) male. At rest, I burn approximately 88.6 kilocalories per hour (1.5 Kcal per minute) and about 2126 calories per day.
The number of calories burned per minute at rest is referred to as a Metabolic Equivalent, or 1 MET. Sitting and using a computer at work is considered to be approximately 1.5 METs, or the metabolic equivalent of one-and-a-half times resting metabolism. Walking slowly around the home, office, or store is estimated to be around 2.0 METs. Cleaning the house, washing windows, vacuuming, cleaning the garage are all about 3.0 METs. Jogging at 5.0 mph is approximately 8 METs, which is the same as playing basketball, singles tennis, or bailing hay.
Lastly, eating also burns calories and the process of digesting some food costs more than others. Up to 20% of the calories from carbohydrates are burned in the process of digestion while only 3% of the calories from fat are used. Some say that broccoli actually costs more energy to digest then it provides. That’s why many diets call high fiber vegetables “free food” and let you eat all you want. We will leave this thermic effect of food out of our equation for now because of the difficulty determining it and consider it a bonus.
In summary, total daily calorie expenditure is a combination of resting metabolism, daily activity, and the energy cost of eating and processing food into energy. Getting a clear picture of how many calories you use each day is the first step before deciding on restricting calories in any way. Now your turn to get an idea of your total caloric expenditure. First, determine how many calories you burn per hour at rest (your weight in kilograms x 1 kcal per kg per hour) and multiply that by the number of hours of rest. Second, determine the caloric expenditure from any structured activity by multiplying the calories you burn per minute at rest by the number of METS for the activity and multiply that by the duration in minutes you perform the activity. Finally, add all calories you burn through rest and activity. That is your estimated total daily caloric expenditure. We will discuss how to manipulate your daily caloric expenditure in future articles.
Here are some useful tools for determining MET levels for different activities:
Forget the fiction, here are the facts...
First things first on your quest for your ideal weight....
If you could do one thing to kick off your quest for your ideal weight, just one thing, that when implemented will kick start your weight loss and improve your health right from the start, what would that be? Of course exercise, that is a given, look who’s writing this. J What else?
No, not diet. Please do not start a diet. What’s the first three letters in the word diet? Please do not fall for any fad diets, any cleanses, diet pills or drinks…that stuff doesn’t help in the long run, I promise you. There is no quick fix or magic potion out there. As Mr. Gold (AKA Rumplestiltskin) says, “Magic always has a price” and he is right. The price is usually a rebound effect at a minimum and poor health or worse at the extreme.
Any good trainer will tell you that the majority of your training occurs in the kitchen. The key is not to cut out food by going on a diet, but to embrace food and eat yourself to your ideal weight. That’s right, eat for the weight you want to be, not for the weight you want to lose (more on that in a future article). So what is step number one? Add fiber and drink water. That’s right, something so simple can be very, very powerful. Women, on average, should have about 28 grams of fiber a day and men should have about 35 grams split fairly evenly in meals and snacks. Now, I am not talking about a fiber pill, supplement or any quick delivery super fiber made in a lab, I am talking about eating real food.
Why focus on eating enough fiber? The average person carries around 5-25 pounds of fecal matter in his or her intestines at any one time depending on their diet. Making sure that every meal has 5-10 grams of fiber from vegetables, fruit, and/or grains will help you carry less weight in fecal matter around with you over time, while avoiding the loss of lean mass, decrease in metabolism, energy loss, and rebound effect that occurs with most “cleanses” or very low calorie diets. Studies have shown that fiber helps lower the risk of cardiovascular disease, obesity, metabolic syndrome, constipation, etc. Click on the following link to read an article from Kathleen Zelman, MPH, RD, LD of WebMD to learn a little more about the health benefits of fiber and what are the best sources: Fiber, how much do we need?
Happy Training!
Sincerely,
Mitchell S. Simon, D.C.
Next step to to achieving your ideal weight...
Once you have incorporated exercise, water and fiber (from veggies, grains, and fruits) into your daily habits, what is the next thing to do to ensure you are on the fast track to achieving your ideal body weight? Answer, eat high quality protein at every meal. The average sedentary individual needs about 0.8 grams of protein for every kilogram of body weight. Individuals that exercise heavily may need over twice that amount. A 200 pound sedentary man needs about 72 grams of protein a day [(200lb/2.2 lb per kg) x 0.8 gram protein= 72 grams protein]. If he is training heavily, he should consume approximately 140+ grams of protein daily.
Personally, I prefer to get my protein from animals (eggs, meat, poultry, fish and pork), beans, rice, nuts, etc. instead of the processed powdered forms; however, I am not opposed to most other people using the various forms of protein supplementation. Some coaches and trainers may argue that it is necessary to use different types of proteins pre and post workout to aid in recuperation, muscle growth, performance, etc. and studies tend to support their assertions. I, on the other hand, enjoy eating real food far too much to want to replace a meal with some highly processed, foul tasting, “naturally flavored” @#$%&!
Most people have no problem getting enough protein on a daily basis until they start cutting calories in an effort to lose weight. Then there are those on the other end of the spectrum that eat up to 4 grams of protein or more per kilogram of body weight. Should they be concerned? Click on the following link to read about high protein diets and its role in weight loss. http://www.webmd.com/diet/guide/high-protein-diet-weight-loss
Happy Training!
Sincerely,
Dr. Simon
High carb, low carb, no carb...what am I suppose to do?
There are a lot of myths and misconceptions floating around about nutrition, and this is especially true when it comes to carbohydrates. Once again, when in doubt, pull the textbooks out. It is important to remember that our brain feeds exclusively on glucose, the most basic molecule carbohydrates are broken down into through the process of digestion. It is estimated that we need about 130 grams of carbohydrates a day just to feed our brain. Since carbohydrates are 4 calories a gram, we need to consume at least 520 calories a day from carbohydrates (130g x 4 calories per gram) just to maintain normal brain activity. Not really interested in thinking clearly and only interested in burning fat? Think about this, at least 50-100 grams of carbs a day are required to prevent ketosis (high levels of ketones in the bloodstream) which results from the incomplete metabolism of fatty acids. That’s right, fat burns in the flame of carbohydrates, so you have to eat carbs if you want to burn fat efficiently!
How many carbs you consume beyond what I described above is based on your activity levels. Glycogen is the storage form of glucose in the body. Approximately 300 grams (1200 calories) of glycogen can be stored in muscle and 75-100 grams stored in the liver. Because dietary carbohydrates replace muscle and liver glycogen used up during exercise, especially very intense exercise, there is no one size fits all amount of carbohydrates a person should consume. According to the NSCA’s Essentials of Personal Training, endurance athletes that train aerobically for long durations of 90 minutes or more should have between 7-10 grams of carbohydrates per kilogram of bodyweight. Just about everyone else can get away with just half of that (5-6 gram per kg body weight). Therefore, a 200 lb (90.9 kg) active male that does not exercise aerobically for an hour or more a day may have as much as 450-545 grams of carbohydrates per day. That is approximately 1800-2180 calories a day from carbohydrates alone.
So in review:
No carbs, no way, that is just plain silly and potentially dangerous.
Low carbs, sure if you are sedentary or have very low activity levels.
High carbs, only if you are an endurance athlete training aerobically for 90 minutes or more a day.
The answer for the majority of us is to have a moderate carbohydrate intake based on goals, training regimen, fitness level, personal taste and eating preferences.
Click on the following link to see what the Harvard School of Public Health has to say about good sources of carbohydrates: http://www.hsph.harvard.edu/nutritionsource/carbohydrates/
Happy Training!
Sincerely,
Dr. Simon
Feeling good about fat once again...
I am sorry to have to be the one to tell you; but, you have been the lied to, scammed, and hypnotized into believing that fat is bad for you. High carb, low fat diets have been touted as the healthier way to go for the last few decades; not necessarily because they are good for you; but, because there is billions and billions of dollars to be made from you eating low-fat, no fat, or fake fat foods. The low-fat revolution paved the way for high fructose corn syrup to invade our food system and not only fatten up the American population; but, help to make it disease ridden as well.
Well, I am here to break the spell and help you fall back in love with all sources of the glorious fat molecule. Up to one-third of all calories we consume should come from fat. That’s right, one third! We should consume between 20-35% of our calories from fat every day in order to have healthy cells, normal hormone balances, and to feel satisfied after a meal. We need fat in our diet to feel happy. What about good fats and bad fats, you might ask? Aren’t animal and trans fats bad, and only plant fats good for you? Not really, you need an equal balance of all types of fats: saturated, unsaturated, and polyunsaturated. So if 30% of your calories need to come from fat, one-third of those calories should be saturated fat, one-third unsaturated, and the remaining third polyunsaturated. That means each type of fat should represent about one tenth of your total caloric intake. Ten percent of your total calories should come from saturated fat, ten percent from unsaturated fat, and ten percent from polyunsaturated fat.
All fats contain all three types of fatty acids. Milk and meat groups are generally high in fat calories, particularly saturated fat. Trimming your meat will generally lower the total calories derived from fat. Lean cuts of poultry and fish generally have less fat content. Trans fatty acids are found naturally occurring in meat, butter, and milk, and are unavoidable when consuming these foods. Many margarines, commercially sold snack cakes, processed foods etc. contain substantial amounts of trans fats and should be avoided.
Most vegetables, beans, fruits, whole grains, nuts, seeds, and avocados have a high proportion of unsaturated fats, except coconut and palm which are high in saturated fats.
A gram of fat has nine calories, over twice as many as protein and carbohydrates, so be careful, the calories add up fast. Click on the following link to read more about incorporating fat into a weight loss program: http://thechart.blogs.cnn.com/2011/06/10/what-foods-have-healthy-fat/
Happy Training!
Sincerely,
Dr. Simon
The effect is profound if you write it down...
Fact: If you write it down, you are likely to reach your target weight more quickly than if you do not write it down.
That’s right, the preponderance of both scientific and anecdotal evidence suggests that just by writing down what you eat and the exercise you do throughout the day increases the speed and the amount of weight loss compared to not keeping this running record. One research study cited by Rosanna Gibbons, MS, RD, LDN in the first article below, concludes that using a smart phone app is even more effective for sticking to a weight loss plan than writing it down by hand. So now, in the palm of your hand, you have the most effective form of keeping a food diary and as a bonus, each app is the equivalent of a team of professionals at your 24 hour beck-and-call assisting you on your journey to achieve and maintain your individual ideal body weight. Some of the better ones are even free!
I want you to notice that I still have not given you a specific diet plan or exercise routine to follow. First, I suggested you focus on drinking water and getting from 25-35 grams of fiber a day from vegetables, whole grains and fruits. Then I suggested you make sure you get 0.8 grams of high quality protein per kilogram of body weight from a variety of sources if you are sedentary, and twice that or more if you are a highly trained athlete. In terms of carbohydrates, I suggested you get 7-10 grams from vegetables, whole grains, and fruits per kilogram of body weight if you exercise aerobically for durations of 90 minutes or more a day. If you do not exercise that long, than you can get away with half that much. The rest of your calories should come from a variety of sources of fat, evenly distributed between saturated, monounsaturated, and polyunsaturated for a total of 20-35 percent of the daily calories.
Otherwise, I do not believe there is a one size fits all plan that works for everyone. In other words, a plan that is designed for everyone works for no one well. We all need to find our own unique combination of foods that nourishes us both emotionally, as well as physically, without being in excess to the point that we store the extra energy on our body as fat and carry it around with us all of the time.
We will talk more about calories later. For now, just write it down.
http://health.yahoo.net/experts/eatbetterlivebetter/smart-phone-diet-apps-part-1-help-weight-loss
http://health.yahoo.net/experts/eatbetterlivebetter/smart-phone-diet-apps-part-2-tools-track-your-food-and-exercise
http://sites.duke.edu/theconnection/2012/06/25/exercise-and-nutrition-apps/
http://www.cbc.ca/news/health/story/2012/01/04/apps-health-fitness-chasing-cures.html
http://lifehacker.com/5726072/the-best-health-and-fitness-apps-for-iphone
Sincerely,
Dr. Simon
How many calories do you burn each day?
Before we discuss how many calories (i.e. kilocalorie or kcal) you should eat each day in order to reach your target weight in a healthy manner as quickly as possible, we first need to get an idea of how many calories you actually burn each day. There are a lot of ways to go about figuring it out; however, one of the ways I consider to be most useful is to first estimate how many calories you burn at rest. Then add on any energy burned through activity and exercise, and even consider the energy cost of eating.
Energy expenditure at rest can be likened to the fuel needed to keep a car engine idling. The average human being consumes approximately 3.5 milliliters of oxygen per kilogram of bodyweight per minute while idling (resting quietly) or the equivalent of about 1 kilocalorie of energy per kilogram of bodyweight per hour. For example, I am a 195 pound (88.6 kilogram) male. At rest, I burn approximately 88.6 kilocalories per hour (1.5 Kcal per minute) and about 2126 calories per day.
The number of calories burned per minute at rest is referred to as a Metabolic Equivalent, or 1 MET. Sitting and using a computer at work is considered to be approximately 1.5 METs, or the metabolic equivalent of one-and-a-half times resting metabolism. Walking slowly around the home, office, or store is estimated to be around 2.0 METs. Cleaning the house, washing windows, vacuuming, cleaning the garage are all about 3.0 METs. Jogging at 5.0 mph is approximately 8 METs, which is the same as playing basketball, singles tennis, or bailing hay.
Lastly, eating also burns calories and the process of digesting some food costs more than others. Up to 20% of the calories from carbohydrates are burned in the process of digestion while only 3% of the calories from fat are used. Some say that broccoli actually costs more energy to digest then it provides. That’s why many diets call high fiber vegetables “free food” and let you eat all you want. We will leave this thermic effect of food out of our equation for now because of the difficulty determining it and consider it a bonus.
In summary, total daily calorie expenditure is a combination of resting metabolism, daily activity, and the energy cost of eating and processing food into energy. Getting a clear picture of how many calories you use each day is the first step before deciding on restricting calories in any way. Now your turn to get an idea of your total caloric expenditure. First, determine how many calories you burn per hour at rest (your weight in kilograms x 1 kcal per kg per hour) and multiply that by the number of hours of rest. Second, determine the caloric expenditure from any structured activity by multiplying the calories you burn per minute at rest by the number of METS for the activity and multiply that by the duration in minutes you perform the activity. Finally, add all calories you burn through rest and activity. That is your estimated total daily caloric expenditure. We will discuss how to manipulate your daily caloric expenditure in future articles.
Here are some useful tools for determining MET levels for different activities:
http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/December/met-hour-equivalents-of-various-physical-activities
http://prevention.sph.sc.edu/tools/docs/documents_compendium.pdf
Happy Training!
Sincerely,
Mitchell S. Simon, D.C.